A Local Hospital’s Fight Against Georgia’s Maternal Mortality Rate

Emory Decatur Hospital’s program uses students to provider personal support for laboring patients.

By Joy Lee

In Georgia, having a child can come with life-threatening risks. The state has one of the highest maternal mortality rates in the United States, hitting underserved communities the hardest. Between 2012 and 2014, 82% of pregnancy-related deaths in Georgia occurred during the postpartum period – many of them preventable. For Black women, the dangers are even greater.

A program at Emory Decatur Hospital hopes to address the gaps in healthcare that lead to poor maternal outcomes across racial lines across the state. The Emory Decatur Labor Support Volunteers (EDLSV) program, launched in 2019, brings student volunteers to witness and actively aid in labor and delivery. This group of volunteers act as a community of doulas, trained in non-clinical labor support. They serve as compassionate caregivers for birthing parents and help to reduce stress, improve outcomes, and provide a better post-partum experience. EDSLV is more than just a service for birthing parents. The program is also an educational opportunity for nursing and other health science students, offering first-hand experience on the clinical side of labor, as well as an opportunity to obtain skills in patient interaction. 

Georgia’s troubling statistics

Pregnancy-related mortality in the United States is the greatest among all high-income countries, and Georgia’s maternal mortality rate sits at twice the national rate. This health disparity disproportionately impacts non-Hispanic Black women, who are nearly 3 times more likely to die from pregnancy-related complicationsthan non-Hispanic White women. The top causes of maternal death in Georgia include cardiovascular conditions, hemorrhage, and mental health conditions, according to the then Georgia Department of Public Health. Pregnancy-related deaths are often multifaceted, though medical factors can play a significant role. A recent CDC survey states that communication issues and disparities in mistreatment during maternity care could also play a role.

Dr. Kate Woeber, an Associate Professor at the University of Nevada Las Vegas and certified nurse-midwife, co-founded the EDLSV program along with Rose L. Horton, CEO of Not On My Watch Consulting Partners and President-Elect of the Association of Women’s Health, Obstetric and Neonatal Nurses. The two were driven by the need to support people who might otherwise labor alone and train future healthcare professionals for such situations.

“There were a couple of instances where I was aware of patients who didn’t have anybody with them,” Dr. Woeber said. “Not because they didn’t want anybody with them, they just didn’t have anybody. And I just thought how scary and lonely that would be.”

With these observations, Dr. Woeber took action. She spoke on a Nursing and Midwifery panel at a Georgia Perinatal Quality Collaborative conference in 2018, where she met Horton. Horton, at the time, was the Director of Labor Services in Decatur. Dr. Woeber approached Horton at the conference and said she wanted to provide her midwifery students with an opportunity to work patients prior to graduation.

“I had a lot of students who just couldn’t wait to get their hands on patients and just be part of the birth process,” Dr. Woeber said. “I had a lot of students without clinical experience as a nurse who could really benefit from having time with laboring people and just getting to grow situational awareness and labor support skills.”

With that, the partnership between Horton and Dr. Woeber began.  

EDLSV deviated from traditional doula care models like similar programs, which involve building a continuous relationship with a patient throughout pregnancy and postpartum. The program developed a shift-based model to accommodate students’ academic schedules to accommodate for student volunteers’ academic schedules.

“Real doulas get to know people during pregnancy and provide support and information… that wasn’t really going to be possible for students who have to be in class at a specific time, so we went with a shift model instead”, said Rose Horton, co-founder of EDSLV. 

Horton has built her career advocating for maternal health with her hashtag “Not On My Watch” and presenting as a Keynote Speaker for national platforms like the Association of Women’s Health, Obstetric and Neonatal Nurses. She emphasizes the importance of specifically midwifery principles in training volunteers in the program: “It was created for midwifery students so that they could learn the techniques of labor support and not rely on the traditional Western medical model.”

Returning midwifery to medicine

The founders view their work as a return to the roots of midwifery, a turn away from late-twentieth century medicalization of birth and toward putting the patient’s experience at the center. 

“For centuries, women have been giving birth to babies, basically unassisted,” Horton said. “When the decision was made that white men should take the lead in birthing babies, and to do it in a hospital, instrumentation grew. Along with instrumentation that they used, mortality started. That had never been an issue before.” 

Horton followed up by saying that although women did die for different reasons before hospitalized births, the exponential growth in mortality is associated with interventions and instrumentation. She acknowledges the usefulness of many of these interventions, but she believes that it should not be the starting place in the birthing process.  The body knows what to do. 

EDLSV deploys volunteers and students to achieve interlocking goals. For patients, EDLSV enhances maternity care by decreasing the number of medical interventions, such as C-sections, Pitocin usage, and epidurals. For clinicians, this program supports the intrapartum caregiving team. For volunteers, EDLSV equips nursing and other healthcare students with interprofessional experience, labor support skills, and an opportunity to build situational awareness .

Dr. Woeber and Horton have both seen the benefits from this program.

“There’s great data that shows that patients who have labor support or who have doulas are less likely to have a C-section,” Horton said. “They’re more likely to have breastmilk feeding, and they are more likely to be very satisfied with their labor process. We have the data that says to give somebody support that’s all theirs, and they’ll have better outcomes.” 

This proves to be true: the positive impact of labor support on maternal outcomes is well-documented. Research has found that doula intervention has been correlated with a decrease in epidural use. The article goes on to say that the education and support that doulas provide can “reduce mental health morbidities, such as PTSD, in mothers without a support system”. 

A study published in eClinical Medicine in 2022 reports that doulas can decrease risk of poor labor outcomes, especially among women from marginalized groups with higher risk for maternal morbidity and mortality, further aligning with the mission of EDLSV

 “It’s an intervention that works, and it’s effective,” Woeber said. “There’s more and more data about how doula care can improve health outcomes for a variety of reasons, and, if it were a medicine, it would be an automatic part of treatment.”

Enriching the student experience

Nicole Pozzo, a coordinator of EDLSV, started off her involvement with the program as a volunteer doula. Her passion for labor and delivery was sparked by a family friend who worked as a doula. “I was looking for clinical experience and was planning to be in Atlanta post-grad for a couple years. Growing up, I heard so many stories about what it meant to be a doula and be part of the process,” Pozzo said. 

Nicole shared her first day on the floor, explaining the events that occurred during her first shift. Pozzo’s first shift was with a family that was having their second child, who understood the labor and birth process and had extended an opportunity to learn from them. 

“I was so nervous,” Pozzo said. “I had gone through the formal orientation and training, but being there for the first time and actively saying ‘I’m here with labor support’ was a little bit scary and nerve wracking. It was a midwife-led birth, which was really cool because I hadn’t had exposure to midwives, only exposure to OBGYN’s.”

The day-to-day role of volunteers on the unit is dynamic; there are six-hour shifts and ten-and-a-half hour shifts. The charge nurse gives each volunteer a list of patients that could benefit from the support given by the program. Volunteers then visit the patients one-by-one, introducing the program and catering to the needs of each family. 

“Some families are like, ‘this is cool, I didn’t even know that this was a service you offered.’ Others are not interested, and that’s okay,” Pozzo added. 

A training process is required before volunteers can begin working with patients. Volunteers practice different skills and become well-versed in the program’s mission by the time they visit their first patient. The lessons taught during the training further reflect EDLSV’s mission of addressing maternal mortality disparities disparities and providing supportive care.  

Volunteers can practice physical techniques with their patients, like counterpressure, aromatherapy, and effective communication strategies for patient interactions. 

This program has equipped Pozzo to be a pillar of support during labor and delivery, but it has also made a lasting impact on her profession and personal growth.

“Being able to be there as a neutral third party and as someone who could just hold space for the emotions that come with labor is an incredible privilege,” she said. “For a lot of folks, birth can be incredibly happy and joyous, but it can also be sad and difficult and vulnerable.” 

EDLSV’s volunteer training and mission-centered focus provide students with labor support skills while raising awareness of systemic inequities before they enter the workforce. As the program continues to grow—with over 90 active volunteers and a waitlist of 65 students—it proves how collective effort, education, and compassion can significantly impact the birthing experience for underserved patients and the providers who serve them.

EDLSV shows that moving in the right direction to change the maternal mortality rate in the United States is possible, but the initiative does not stop here. Greater investment and similar initiatives are necessary to provide equitable care grounded in evidence for birthing individuals. 

“There’s an opportunity for us to go back to the premise that pregnancy, labor and birth are normal, physiologic events,” Horton said. “They’re not states of diseases that require intervention.”